CBT-I Patient Assessment & Treatment Planning 2 — Questions and Answers
Question 1: A patient reports spending 9 hours in bed but only sleeping 5 hours. What does this indicate about their sleep efficiency?
- Sleep efficiency of 56%, below the therapeutic threshold (Correct answer)
- Sleep efficiency of 90%, within normal range
- Sleep efficiency of 75%, acceptable for older adults
- Sleep efficiency cannot be calculated from this data
Correct answer: Sleep efficiency of 56%, below the therapeutic threshold
Sleep efficiency (SE) = total sleep time / time in bed × 100; 5/9 = 56%, well below the 85% target used in CBT-I.
Question 2: Which validated instrument specifically measures dysfunctional beliefs and attitudes about sleep relevant to CBT-I planning?
- Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS) (Correct answer)
- Pittsburgh Sleep Quality Index (PSQI)
- Epworth Sleepiness Scale (ESS)
- Insomnia Severity Index (ISI)
Correct answer: Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS)
The DBAS-16 directly assesses maladaptive cognitions about sleep, making it the primary tool for identifying cognitive targets in CBT-I.
Question 3: A new patient presents with chronic insomnia and reports using alcohol nightly to fall asleep. What is the priority assessment step?
- Evaluate alcohol use disorder severity and its relationship to insomnia onset (Correct answer)
- Begin sleep restriction therapy immediately
- Prescribe a sleep diary and reassess in 2 weeks
- Rule out circadian rhythm disorder first
Correct answer: Evaluate alcohol use disorder severity and its relationship to insomnia onset
Comorbid alcohol use disorder must be assessed first because alcohol-dependent sleep onset is a contraindication to standard CBT-I sequencing and requires coordinated treatment.
Question 4: When using the ISI to track treatment progress, which score range indicates clinical insomnia in the moderate severity category?
- 15–21 (Correct answer)
- 0–7
- 8–14
- 22–28
Correct answer: 15–21
ISI scores of 15–21 indicate moderately severe clinical insomnia; scores 22–28 indicate severe insomnia.
Question 5: A sleep diary reveals a patient's sleep onset latency (SOL) averages 65 minutes across two weeks. Which CBT-I component most directly targets this finding?
- Stimulus control therapy (Correct answer)
- Sleep hygiene education
- Relaxation training only
- Cognitive restructuring only
Correct answer: Stimulus control therapy
Stimulus control therapy re-associates the bed with sleepiness by restricting bed use to sleep and sex, directly reducing prolonged SOL.
Question 6: Which of the following findings on initial assessment would most likely prompt referral before starting standard CBT-I?
- Witnessed apneas and loud snoring reported by bed partner (Correct answer)
- Sleep onset latency of 30 minutes most nights
- Pre-sleep worry about next-day performance
- Daytime fatigue without excessive sleepiness
Correct answer: Witnessed apneas and loud snoring reported by bed partner
Witnessed apneas and snoring suggest obstructive sleep apnea, which requires polysomnography and treatment (often CPAP) before or alongside CBT-I.
Question 7: In the three-P model used for CBT-I case conceptualization, which factor represents ongoing cognitive and behavioral patterns that maintain insomnia?
- Perpetuating factors (Correct answer)
- Predisposing factors
- Precipitating factors
- Protective factors
Correct answer: Perpetuating factors
Perpetuating factors (e.g., excessive time in bed, napping, caffeine use, worry about sleep) are the primary targets of CBT-I intervention.
CBT-I Patient Assessment & Treatment Planning 2
A patient reports spending 9 hours in bed but only sleeping 5 hours.
What does this indicate about their sleep efficiency?